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Effects of bench press technique variations on musculoskeletal shoulder loads and potential injury risk. Noteboom, et al. (2024) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic/Preventative Topic: Bench pressing - How far apart should hands be? This biomechanical study assessed how bench press techniques, including grip width, scapula pose, and shoulder abduction angle, influence reaction forces in the glenohumeral and acromioclavicular joints. Using a musculoskeletal model, researchers analysed various conditions to determine their impact on joint forces. The results that narrower grips (less than 1.5 times acromion to acromion distance) and scapula retraction reduce compression and shear forces on these joints, potentially lowering the risk of injuries such as distal clavicular osteolysis and rotator cuff issues. The study also highlights significant individual differences in how lifters apply mediolateral force to the barbell, with less experienced participants tending to exert more inward force, which increases joint stress. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, narrower grip (less than 1.5 times shoulder width) and scapular retraction reduce compression and shear forces on the glenohumeral and acromioclavicular joints. Keep in mind that pushing exercises for the upper limb should be part of a healthy upper limb resistance training for all people. URL: https://doi.org/10.3389/fphys.2024.1393235 Abstract While shoulder injuries resulting from the bench press exercise are commonly reported, no biomechanical evidence for lowering injury risk is currently available. Therefore, the aim of the present study was to compare musculoskeletal shoulder loads and potential injury risk during several bench press variations. Ten experienced strength athletes performed 21 technical variations of the barbell bench press, including variations in grip width of 1,1.5 and 2 bi-acromial widths (BAW), shoulder abduction angles of 45°, 70° and 90°, and scapula poses including neutral, retracted, and released conditions. Motions and forces were recorded by an opto-electronic measurement system and an instrumented barbell. An OpenSim musculoskeletal shoulder model was employed to estimate joint reaction forces in the glenohumeral and acromioclavicular joints. Time-series of joint reaction forces were compared between techniques by statistical non-parametric mapping. Results showed that narrower grip widths of <1.5 BAW decreased acromioclavicular compression (p < 0.05), which may decrease the risk for distal clavicular osteolysis. Moreover, scapula retraction, as well as a grip width of <1.5 BAW (p < 0.05), decreased glenohumeral posterior shear force components and rotator cuff activity and may decrease the risk for glenohumeral instability and rotator cuff injuries. Furthermore, results showed that mediolaterally exerted barbell force components varied considerably between athletes and largely affected shoulder reaction forces. It can be concluded that the grip width, scapula pose and mediolateral exerted barbell forces during the bench press influence musculoskeletal shoulder loads and the potential injury risk. Results of this study can contribute to safer bench press training guidelines. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Masson Tumour: A rare cause of a hand lump. Gunawardena et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic Topic: Thenar mass - Hammer syndrome vs others A 40-year-old male patient initially presented with a progressively enlarging soft tissue lump at the base of his thumb, which was clinically and radiologically suspected to be a post-traumatic false aneurysm following blunt trauma (patient hand been using their hand as a hammer). However, histopathological examination after surgical excision revealed an intravascular papillary endothelial hyperplasia (IPEH), also known as Masson tumour. The lesion appeared as a well-defined mass on imaging, with features suggestive of a thrombosed aneurysm. Despite this particular tumor been benignis it is fundamental to differentiate it from more aggressive vascular lesions like angiosarcomas. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know, a hand lump that looks like a hammer or hypothenar hammer syndrome should be surgically excised to exclude the presence of a malignant angiosarcoma. Thus, these presentations are not distinguishable from each others based on clinical or imaging presentations. In most instances, hand lumps in the palm are benign vascular lesions or more rarely a Masson tumour. If you are interested in reading more about a hypothenar hammer syndrome presentation, have a look at this synopsis. URL: https://doi.org/10.1142/S2424835525720099 Abstract Intravascular papillary endothelial hyperplasia, also known as Masson tumour, is a rare proliferative vascular lesion that can affect the hand. We report a patient who was operated on for a progressively enlarging soft tissue lump at the base of his thumb. Initially, it was thought to be a post-traumatic false aneurysm arising from a branch of the radial artery following blunt trauma. Subsequent histology revealed it to be a Masson tumour. We aim to highlight this rare pathology that can affect the hand and the diagnostic confusion we faced during the evaluation and management of this patient. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Resistance training prescription for muscle strength and hypertrophy in healthy adults: A systematic review and bayesian network meta-analysis. Currier, et al. (2023) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 👍 (/4 Thumbs up) Type of study: Therapeutic Topic: Resistance training - Strength and hypertrophy This systematic review assessed resistance training (RT) frequency and loads for maximising skeletal muscle mass and strength outcomes in healthy adults. A total of 192 randomised controlled studies were included. The results showed that higher frequencies (e.g., 4–5 times per week) generally yield greater benefits for muscle growth and strength improvements compared to lower frequencies. However, moderate frequencies (3–4 times per week) were also effective when combined with sufficient training intensity and volume. Key findings include the importance of individualizing RT frequency based on factors such as recovery capacity, training goals, and daily life constraints. While higher frequencies are ideal for maximising adaptations, moderate frequencies remain a viable option for those seeking to maintain long-term adherence. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, the higher the overall exercise volume (sets x reps x intensity) the greater the hypertrophy with higher exercise intensity being important if the focus is improving strength. Training (3–4 times per week) remains a very effective solution, especially for those people requiring more recovery time. Weekly training despite frequency remains one of the most important aspects with even little bouts of resistance training being much better than no exercise for strength and hypertrophy. Remember that lifting is not only for muscle strength and hypertrophy but for bone health too. URL: https://doi.org/10.1136/bjsports-2023-106807 Abstract Objective: To determine how distinct combinations of resistance training prescription (RTx) variables (load, sets and frequency) affect muscle strength and hypertrophy. Data sources MEDLINE, Embase, Emcare, SPORTDiscus, CINAHL, and Web of Science were searched until February 2022. Eligibility criteria: Randomised trials that included healthy adults, compared at least 2 predefined conditions (non-exercise control (CTRL) and 12 RTx, differentiated by load, sets and/or weekly frequency), and reported muscle strength and/or hypertrophy were included. Analyses: Systematic review and Bayesian network meta-analysis methodology was used to compare RTxs and CTRL. Surface under the cumulative ranking curve values were used to rank conditions. Confidence was assessed with threshold analysis. Results: The strength network included 178 studies (n=5097; women=45%). The hypertrophy network included 119 studies (n=3364; women=47%). All RTxs were superior to CTRL for muscle strength and hypertrophy. Higher-load (>80% of single repetition maximum) prescriptions maximised strength gains, and all prescriptions comparably promoted muscle hypertrophy. While the calculated effects of many prescriptions were similar, higher-load, multiset, thrice-weekly training (standardised mean difference (95% credible interval); 1.60 (1.38 to 1.82) vs CTRL) was the highest-ranked RTx for strength, and higher-load, multiset, twice-weekly training (0.66 (0.47 to 0.85) vs CTRL) was the highest-ranked RTx for hypertrophy. Threshold analysis demonstrated these results were extremely robust. Conclusion: All RTx promoted strength and hypertrophy compared with no exercise. The highest-ranked prescriptions for strength involved higher loads, whereas the highest-ranked prescriptions for hypertrophy included multiple sets. PROSPERO registration number: CRD42021259663 and CRD42021258902. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Sex differences in orthosis wear on pain, function, and grip in patients with thumb carpometacarpal joint osteoarthritis. Gasavi Nezhad, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Sex differences - Thumb OA This quasi-experimental study assessed the impact of a custom hand-based orthosis on grip strength, pinch strength, pain reduction, and daily activities performance among individuals with thumb osteoarthritis OA. A total of 28 participants (14 females) were included in the study. Participants were asked to wear a custom thumb splint during the day. The results showed that female participants reported statistically higher satisfaction with their hand function. However, this was the only statistically significant difference out of eight comparisons made. What this suggests is that there is a 40% chance that these results are due to random findings. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, women report higher satisfaction with their hand function compared to males when utilising hand splints for hand OA. Nevertheless, this was the only significant difference suggesting that there is a very real possibility the results are a fluke. Furthermore, the largest randomised controlled study for thumb OA has shown that splints/sham splints are as effective as a self management program for this presentation. URL: https://doi.org/10.1177/17589983251372951 Abstract Introduction: To our knowledge, no previous studies have directly compared the effects of orthosis wear in males and females with thumb carpometacarpal (CMC) joint osteoarthritis. Therefore, this study aimed to analyze whether there are differences between males and females in pain, hand function, and grip strength following hand-based orthosis wear. Methods: The study included 14 male and 14 female participants with first- and second-degree CMC joint osteoarthritis. A hand-based orthosis was custom-molded for each participant. Pain, function, grip strength, and pinch strength were evaluated at baseline and after a 6-week period of orthosis wear. Results: Twenty-eight participants (mean age: males 64.6 ± 5.1 years; females 63.5 ± 3.2 years) completed the study. After 6 weeks of orthosis use, both males and females showed significant improvements in grip strength, pinch strength, hand function, daily activity performance, and pain reduction (all p < .05). Although both sexes benefited similarly in grip strength, pain, and function, females reported significantly greater improvement in satisfaction with hand function (p = .020). Mean adherence was 84.75%, with higher compliance observed in females. Conclusion: Although both groups experienced significant improvements in pain, function, grip strength, pinch strength, and overall satisfaction with orthosis wear, greater improvement in satisfaction with hand function was observed among females. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

The management of non-traumatic wrist disorders: A national survey of practice. Mitchell, et al. (2025) Level of Evidence: 2c Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic, Therapeutic Topic: Non-traumatic wrist - Management variability This survey study explored the management of non-traumatic wrist disorders (NTWD) by healthcare professionals, focusing on diagnostic confidence, treatment approaches, and the use of outcome measures across different clinical settings and professional groups. Key findings revealed variability in clinician confidence in achieving specific diagnoses, with general practitioners (GPs) being less confident in reductive diagnosis, but more confident in managing NTWD compared to musculoskeletal rehabilitation practitioners. The study highlights that diagnostic confidence does not necessarily correlate with effective management, suggesting that non-specific approaches may be sufficient for many cases. Variability was also observed in the use of patient-reported outcome measures (PROMs), with primary care clinicians using them less frequently than those in secondary care, often for non-clinical purposes such as audit or research. The authors suggest to adopt a broader, person-centred approach to managing NTWD, aligning with principles of holistic care and the use of outcome measures to improve consistency in assessment and treatment outcomes. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, there is variability in confidence among healthcare professionals when diagnosing and managing non-traumatic wrist disorders (NTWD), with general practitioners (GPs) less confident in making a definitive diagnoses but more confident overall in management compared to musculoskeletal therapists. This may be due to the fact that despite a precise diagnosis, non-traumatic musculoskeletal presentations tend to improve over time without specific treatments. This is unless we have know predictors of poor outcomes such as mental health issues/higher pain levels, worse social deprivation, or higher levels of pain catastrophising. Keep this factors in mind so you will be more effective in managing your patients, independently of nailing the exact diagnosis. URL: https://doi.org/10.1177/17589983251372949 Abstract Introduction: Non-traumatic wrist disorders (NTWD) are commonly encountered across care settings, but current patterns of care and clinicians beliefs about the care they provide remains unclear. Objective: This study aimed to record management approaches to care for NTWD across clinical groups and care settings. Methods: Ethical approval was sought for an online cross-sectional survey of clinicians [1 Jul - 1 Nov 2023], comprising 18 questions exploring profession, work setting, exposure to NTWD, alongside diagnostic and management confidence. UK-based musculoskeletal (MSK) clinicians were invited to participate through special interest groups, online forums, social media and professional network emails. Results: Variability was found in the domains of specificity of diagnosis and confidence in management which relates to exposure and profession. Variability was found in the domains of specificity of diagnosis and confidence in management which relates to exposure, profession and clinical setting. Several Patient Related Objective Measures (PROMS) were used by clinicians to assess treatment effect, set goals, and communicate with patients. Conclusion: This study provides the first description of UK clinicians management of non-traumatic wrist disorders across professional groups and healthcare settings. As evidence-based management remains elusive, deeper understanding of the clinical decision-making and practice behaviour of clinicians would have value in future studies into NTWD. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Deep transverse metacarpal ligament instability and extensor quadriga secondary to a boxer’s fracture. Heijerman, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Therapeutic Topic: Deep transverse metacarpal ligament - Laxity This case report describes a rare progression of complications following a boxer’s fracture in a 49-year-old female hand therapist. Initially treated non-surgically after sustaining a fifth metacarpal neck fracture, she developed significant angular deformity, and pain over the next two years. Despite corrective osteotomy and subsequent interventions, her condition deteriorated due to deep transverse metacarpal ligament (DTML) instability, extensor tendon subluxation, and arthrogenic muscle inhibition (AMI). After multiple failed treatments, including K-wire stabilization, a palmaris longus tendon loop procedure was performed to stabilize the DTML and restore metacarpal alignment. After this surgery, the patient achieved full functional recovery with pain relief and near-normal grip strength. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, in rare instances, following a boxer’s fracture the deep transverse metacarpal ligament (DTML) is injured contributing to mcpj extension loss and carpometacarpal instability. Reconstruction of the DTML via palmaris longus tendon loop resolved the patient's pain and allowed them to achieve good functional outcomes. Injuries to the DTML have been previously described and another presentation you need to be aware of is saddle syndrome. For another wonderful and unusual presentation of little finger drift without evidence of ulnar nerve involvement, have a look at this synopsis on third lumbrical avaulsion. URL: https://doi.org/10.1177/17531934251365582 No Abstract available publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Distal Radioulnar Joint Instability. Murdoch, et al. (2025) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: DRUJ instability - What do do? This expert opinion provides a comprehensive review of the management strategies for distal radioulnar joint (DRUJ) instability with additional focus on the role of Triangular fibrocartilage complex (TFCC) in DRUJ stability. TFCC tears involving the DRUJ are often missed because their symptoms overlap with other wrist pathologies, yet they can lead to chronic pain, functional loss and instability if left untreated. In certain instances, isolated peripheral TFCC lesions do not disturb DRUJ stability, and in these cases a long‑arm cast or splint allows spontaneous healing. Surgical intervention are often required when the tear involves the foveal attachment or creates clinical instability of the DRUJ, especially after distal radius fractures. Surgical options include both open (dorsolateral‑ulnar) and arthroscopic techniques that aim to re‑attach the torn TFCC to restore foveal integrity. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, DRUJ laxity often requires surgical stabilisation if it is symptomatic. The author mentions how especially after distal radius fracture DRUJ instability needs to be repaired. Keep in mind that 60% of people who have DRUJ laxitiy following distal radius ORIF have a stable joint at 6 months. It is therefore possible that DRUJ repair may only be required in a small subset of people. As a matter of fact, routine stabilisation of the DRUJ for a distal radius fracture may cause more supination/pronation ROM limitations compared to not repairing it. If you are interested to know more about DRUJ stability tests or management options, have a look at the entire database on the topic. URL: https://doi.org/10.1142/S2424835525400089 Abstract The articulation of the distal radioulnar joint (DRUJ) has minimal osseous constraint and relies on a number of other primary and secondary structures for stability and normal function. DRUJ instability is a challenging clinical problem, and osseous, chondral and ligamentous factors can all contribute to the pathology – often in combination. A thorough understanding of the aetiology, clinical presentation and imaging findings of DRUJ instability are important when determining the best management strategy. This review covers anatomy, kinematics, aetiology, imaging findings and surgical management of DRUJ instability for both acute and chronic presentations. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Risk factors affecting rotator cuff retear after arthroscopic repair: A meta-analysis and systematic review. Zhao, et al. (2021) Level of Evidence: 2a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Prognostic Topic: RC repair - re-tear This systematic review and meta-analysis investigated what factors are associated with rotator cuff (RC) tear retears after arthroscopic repair. A total of fourteen studies including more than 5,500 participants were included in the study. The studies were either retrospective or cross-sectional in nature. The results showed that the incidence of re-tears was 16% (n = 914). Factors associated with re-tears were older age, greater body mass index, and the presence of diabetes mellitus, fatty infiltration in the rotator cuff, longer symptom duration, lower bone mass density, larger tear size, and RC belly retraction were significantly associated with retear. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, rotator cuff retear after repair is more common in oolder paople (1 in 2 people after 70 yrs old), people with greater body mass index (BMI), diabetes mellitus, and longer symptom duration. This may be useful in advising our patients pre-surgically, if we have the opportunity of helping them making a decision. For younger patients after a FOOSH, it is useful to be able to pick these injuries up earlier and an example of such case study has been presented previously. If you would like to keep it simple and want a couple of test to assess the rotator cuff, have a look at this synopsis. URL: https://doi.org/10.1016/j.jse.2021.05.010 Abstract Background: Retear after arthroscopic rotator cuff repair (ARCR) consistently challenges medical staff and patients, and the incidence of retear after surgery is 10%-94%. The purpose of this study was to identify the risk factors that cause retear after ARCR and provide theoretical guidance for clinical intervention to reduce the occurrence of postoperative rotator cuff retear. Methods: The protocol for this meta-analysis was registered with PROSPERO (CRD42021225088). PubMed, Web of Science, and Embase were searched for observational studies on risk factors for rotator cuff retear after arthroscopic repair. Meta-analytical methods were used to determine the odds ratio or weighted mean difference of potential risk factors related to postoperative rotator cuff retear. Stata 15.1 was used to quantitatively evaluate the publication bias of the statistical results. Results: Fourteen studies from 6 countries with a total of 5693 patients were included. The meta-analysis revealed that the risk factors for retear after rotator cuff repair were age, body mass index, diabetes, subscapularis and infraspinatus fatty infiltration, symptom duration, bone mineral density, tear length, tear width, tear size area, amount of retraction, critical shoulder angle, acromiohumeral interval, distance from the musculotendinous junction to the glenoid, operative duration, biceps procedure, and postoperative University of California Los Angeles shoulder score. Conclusion: These findings can help clinical medical staff identify patients who are prone to retear early after arthroscopic repair and develop targeted prevention and treatment strategies for modifiable risk factors, which are of great significance for reducing the occurrence of rotator cuff retear after ARCR. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Reducing health care’s carbon footprint: The environmental impact of telephone clinic visits for hand surgery. Arora, et al. (2025) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Economic and Decision Analysis Topic: Phone consultations - Benefits The study evaluates the environmental impact of telephone clinics, focusing on postoperative care. Data from 2022 to 2023 were included, for a total of 416 phone calls to 295 patients. Greenhouse gas emissions and gasoline consumption savings were calculated alongside pooling of phone calls reasons and care escalation incidence. The results showed that by using phone consultation, greenhouse effect significantly dropped due to reduction in gasoline consumption equal to growing more than 800 trees from seed for 10 years. Moreover, it saved patients more than 2,000 hours of traveling time. The most common reasons for phone consultation included communication of imaging review, counseling/answering questions, and post-surgical follow up. Care was escalated with in person encounter in 12% of cases for assessment of potential complication and the reporting of new complaints. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, phone consultation are beneficial for the environment and for patients by reducing emissions and saving people time and money that would be otherwise be spent traveling. Imaging review, counseling patients, and making sure that their post-surgical is going smoothly are common reasons justifying the use of phone consultations. Evidence of the benefits of telehealth have been reported before for hand related presentations as well as for shoulder second opinions. If you are interested in other ways to reduce your carbon footprint in hand therapy, have a look at this other synopsis. URL: https://doi.org/10.1016/j.jhsa.2025.06.010 Abstract Purpose: The health care sector contributes substantially to global greenhouse gas emissions. Telehealth presents an opportunity for reducing health care–associated emissions and patient transportation burden. This study analyzed the environmental and clinical outcomes of telephone encounters conducted at a Veterans Affairs Medical Center Hand Clinic between June 2022 and June 2023. We hypothesized that telehealth would reduce carbon emissions while maintaining effective patient care. Methods: We conducted a retrospective review of 416 telephone encounters involving 295 patients. Patient demographics, travel distances, and emissions data were collected. Carbon dioxide (CO2) emissions and gasoline savings were calculated based on avoided travel distances. Encounters were categorized as telephone-managed (concerns addressed via telephone) or telephone-facilitated escalation of care (recommendation for in-person follow-up). Results: Of the encounters evaluated, 88.1% were telephone-managed, and 11.9% identified the need for an in-person evaluation. The study demonstrated a reduction in travel-related CO2 emissions (51,920 kg total, 54 kg per encounter) and gasoline savings (5841 gallons), with a median driving distance saved of 129.9 miles per encounter. The environmental impact of telehealth was equivalent to recycling 2258 bags of waste or growing 866 tree seedlings for 10 years. Moreover, telephone encounters saved patients over 2180 hours of travel time and $29,847 in gasoline costs. Conclusions: Most telephone encounters were successfully managed without further intervention, whereas a subset appropriately resulted in an in-person evaluation. These findings highlight the value of telehealth in supporting clinical decision-making and demonstrate its potential to reduce travel distance, time, and fuel consumption, particularly for patients living far from specialty care. Clinical relevance: Telephone encounters offer a means of managing hand conditions and postoperative care remotely, reducing travel burdens and environmental impact while still facilitating timely in-person evaluations when necessary. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Articular surface damage following headless intramedullary nail fixation of proximal phalanx fractures. Bekisz, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic: Intramedullary nail - Proximal phalanx This cadaver study assessed the use of intramedullary nails for treating proximal phalangeal fractures, comparing antegrade and trans-articular techniques. A total of 56 phalanges from seven different cadavers were included in this study. Antegrade placement (from proximal to distal) and trans-articular (from within the joint) approaches produced similar cartilage defects (around 3%) and extensor tendon involvement was equally similar (9% of fingers). Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, the articular damage of associated with antegrade and trans-articular nail placement is similar when treating proximal phalanx fractures. This is good to know as some elite sports players may elect to have surgery and return to sport as soon as possible rather than waiting for secondary intention healing. It is also important to remember that about 1 in 10 patients treated with intramedullary nail of their proximal phalanx present with extensor tendon injury, which may lead to abrasion over time. URL: https://doi.org/10.1016/j.jhsa.2024.07.005 Abstract Purpose: Offering the benefits of rigid fixation while minimizing soft tissue dissection, intramedullary implants have become a popular choice among hand surgeons. Their placement often requires traversing or passing in proximity to joint surfaces. This study aimed to assess the damage to the articular cartilage of the base of the proximal phalanx resulting from antegrade placement of threaded headless intramedullary nails. Methods: A cadaveric study comparing two techniques for antegrade placement of threaded headless intramedullary nails was conducted in 56 digits. The first entailed a single 2.1 mm intramedullary nail placed via the dorsal base of the proximal phalanx, whereas the second used two 1.8 mm intramedullary nails inserted via the collateral recesses of the phalangeal base. All specimens were analyzed for articular surface damage with the cartilage defect measured as a percentage of total joint surface area. Damage to the extensor tendons was also assessed in a subset of specimens. Results: No significant difference in the percentage of articular surface damage was observed, with an average 3.21% ± 2.34% defect in the single 2.1 mm nail group and a 2.71% ± 3.42% mean defect in the two 1.8 mm nails group. There was no articular surface injury in 18% of digits in each group. Damage to extensor tendons was seen in three (9.4%) specimens and in all cases involved either the extensor indicis proprius or extensor digiti minimi. Conclusions: Hardware insertion using either the dorsal base of the proximal phalanx or the collateral recesses of the phalangeal base both demonstrated minimal articular cartilage damage and infrequent injury to the extensor tendons. Clinical Relevance: With proper technique for antegrade insertion into the proximal phalanx, the cartilage defect observed often encompasses only a small percentage of the overall joint surface area. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Textbooks vs. Journal articles: How to appreciate and understand their limitations. Tang, et al. (2025) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Diagnostic/Therapeutic Topic: Textbook vs journal articles - Perils The paper discusses the roles of textbooks and journal articles in hand surgery education, highlighting their respective strengths and limitations. Textbooks provide foundational knowledge but can sometimes propagate misconceptions or outdated advice that may not apply universally. In contrast, journal articles, particularly expert-authored review pieces, offer current insights and exposure to diverse opinions, which is beneficial for advanced learning. The authors propose integrating the benefits of both formats through multi-author textbook chapters led by expert teams. While this approach has potential advantages, it also acknowledges the challenges in coordinating such efforts. Ultimately, textbooks are valuable for introductory understanding, while journal articles are essential for staying informed and advancing professional skills. The paper emphasises the importance of critically evaluating sources to build upon existing knowledge and drive innovation. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, textbooks are essential for providing foundational knowledge, but they may sometimes propagate misconceptions or outdated advice. Not cross-referencing textbooks with current research could lead to sub-optimal clinical decisions. In contrast, journal articles, especially expert-authored reviews pieces, offer the advantage of up-to-date insights and exposure to diverse opinions, which is crucial for advanced learning and staying informed about the latest developments in hand therapy/surgery. If you want to have a deeper dive into research and clinical practice implementation have a look at the dataset on the topic. URL: https://doi.org/10.1177/17531934241307497 Abstract In this article, we examine the pros and cons of textbook vs. journal articles. We suggest that textbooks serve as an essential knowledge provider for colleagues, especially at their entry level, but to advance clinical and academic capability, journal articles remain an important and unreplaceable tool for continuous professional development. Currently multi-author review articles provide one of the best sources of information, providing recommendations that are authoritative yet balanced. We explored if there are options to combine the best of both these platforms of information. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

The effect of radial collateral ligament plication on varus stability in a sequential injury model of the lateral elbow: A biomechanical study. So, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic: RCL plication - Elbow stability This study assessed the effects of radial collateral ligament (RCL) plication following partial common extensor origin (CEO) tear, partial RCL tears, and full RCL tears. The effect of the ligament plication was assessed by measuring the amount of elbow varus induced by an extenal load on the elbow. A total of eight cadavers were included in the study. The results showed that varus angle measurements increased with partial lesions of the CEO and partial full/lesions of the RCL. Plication of the RCL reduced varus laxity under the partial CEO and RCL tear, however, when a full tear of the RCL was present, the amount of varus laxity was still greater than in a healthy elbow. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, radial collateral ligament plication was helpful in reducing the amount of elbow laxity when partial tears of the CEO or RCL were present. This seems to be in line with a clinical study suggesting that LUCL repair is helpful in people with postero lateral rotatory instability of the elbow. This study also reminds us that the CEO has an important varus stability role in addition to its role as a tendon. URL: https://doi.org/10.1016/j.jse.2025.06.018 Abstract Background: Insufficiency of the radial collateral ligament (RCL) can lead to symptomatic minor instability of the lateral elbow. While RCL plication showed favorable clinical outcomes in treating symptomatic minor instability of the lateral elbow, its biomechanical impact on varus stability remains unclear, particularly with regard to how effectively RCL plication can restore stability compared to an intact elbow across various degrees of lateral elbow injury. This study was to evaluate the impact of RCL plication on varus stability in a model of sequential lateral elbow injury under controlled varus load. Methods: A custom-made device was used to test 8 fresh-frozen cadaveric specimens (60° of elbow flexion) under a controlled varus load. We examined 7 conditions: intact elbow, 3 sequential injury scenarios (anterior half of the common extensor origin [CEO] release, partial RCL release, and complete RCL release), and 3 conditions after RCL plication for the respective injury conditions. Each specimen was tested under 3 varus loads (gravity alone, and additional 0.5 and 1 kg applied to the hand). True anteroposterior radiographs of the elbow were acquired in each condition to measure the varus angle and evaluate varus stability. Results: RCL plication significantly reduced varus angle in cases of anterior half of the CEO and partial RCL release across all tested loads compared to their respective pre-plication states, while a significant reduction was not observed after RCL plication in the condition involving complete RCL release. At all load levels, varus angles in cases of RCL plication for anterior half of the CEO and partial RCL release showed no significant difference from intact elbow. However, RCL plication in complete RCL release exhibited a significantly larger varus angle than the intact elbow. Conclusion: RCL plication in both anterior half of the CEO and partial RCL releases significantly improved varus stability when compared to their respective injury conditions and achieved varus stability that was comparable to that of the intact elbow. However, RCL plication in complete RCL release did not significantly improve varus stability and exhibited inferior varus stability compared to the intact elbow. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings